In consideration of Empact Northwest (DBA Empact International) arranging a volunteer assignment for me, and with the intention of binding myself, my heirs, legal representative, successors and assigns, I hereby expressly RELEASE AND FOREVER DISCHARGE Empact Northwest, its officers, directors, employees, volunteers, agents, legal representatives, insurers, successors, and assigns from any and all claims, demands, damages, liabilities, and causes of action that I now have or may in the future have, whether known or unknown, of whatsoever nature, relating to or arising out of my selection as a volunteer by, or my service as a volunteer with, Empact Northwest whether or not due to Empact Northwest's negligence, strict liability, or any other breach or fault.  This includes, but is expressly not limited to, death, bodily injury, personal injury, property damage, loss or theft of property, economic loss, or any other damage, loss or cost.

 

I understand that volunteering to provide medical aid, rescue, or relief in a post-disaster setting or developing nation is inherently dangerous and may result in injury, illness, death, or damage or loss of personal property.

 

I understand that Empact Northwest provides limited medical, evacuation, and/or life insurance to cover bodily injury, illness or death.  I further understand that Empact Northwest does not provide significant long term disability insurance or "workers compensation".

 

This document shall be construed as broadly as possible according to the laws of the state of Washington and is intended to be as broad and inclusive as permitted by the laws of the State of Washington.  If a dispute should arise with respect to the meaning of any of the terms of this document, the rule of construction that a document is construed against the party preparing such document shall specifically not be applicable to the interpretation of this document. Should any portion of this agreement be held invalid, I agree that the balance shall, notwithstanding, continue in full legal force and effect.

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I understand that in the course of my volunteer work for Empact Northwest, I may have access to or hear about confidential or sensitive information.  I understand that it is my responsibility not to reveal this information.  I further understand that sensitive information may be used only as it pertains to my work as a volunteer, and it should not be shared with others outside Empact Northwest.  Examples of confidential information include but are not limited to donor or volunteer names, telephone numbers, places of employment, financial information, or other sensitive information.  I understand that breach of this confidentiality may result in a termination of my volunteer role with Empact Northwest.

 

I understand that Empact Northwest may use my name and any photographs and/or video of me for publicity or promotional purposes without liability or obligation to me and consent to such user.

 

I understand that Empact Northwest takes patient privacy very seriously.  I agree to uphold the highest standard of patient privacy and to maintain appropriate confidentiality at all times.

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This General Release represents the entire agreement of the parties hereto and supersedes any and all prior or contemporaneous oral or written understandings, statements, representations or promises.  All of the terms hereof are contractual and not mere recitals.

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I acknowledge that I have carefully read this General Release and Terms & Conditions, know and understand the contents thereof, and that this document was freely and voluntarily executed.  I acknowledge that I was given the opportunity to seek independent legal counsel on any and all matters herein before I signed this General Release and Terms & Conditions.